SENATE, No. 3798
STATE OF NEW JERSEY
INTRODUCED MAY 20, 2021
Senator JOSEPH F. VITALE
District 19 (Middlesex)
Senator SHIRLEY K. TURNER
District 15 (Hunterdon and Mercer)
Assemblywoman YVONNE LOPEZ
District 19 (Middlesex)
Assemblyman DANIEL R. BENSON
District 14 (Mercer and Middlesex)
Assemblyman GORDON M. JOHNSON
District 37 (Bergen)
Senator Madden, Assemblywomen Speight, Vainieri Huttle, Murphy, Assemblyman Wimberly, Assemblywomen Reynolds-Jackson and Lampitt
Eliminates premiums and waiting periods for certain NJ FamilyCare enrollees and directs DHS to implement additional targeted outreach initiatives to increase enrollment.
CURRENT VERSION OF TEXT
As reported by the Senate Budget and Appropriations Committee on June 21, 2021, with amendments.
An Act concerning NJ FamilyCare 2[,] and2 amending P.L.2005, c.156 and P.L.2008, c.38 1[, and making an appropriation]1 2.2
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 5 of P.L.2005, c.156 (C.30:4J-12) is amended to read as follows:
5. a. The purpose of the program shall be to provide subsidized health insurance coverage, and other health care benefits as determined by the commissioner, to children under 19 years of age and their parents or caretakers and to adults without dependent children, within the limits of funds appropriated or otherwise made available for the program.
The program [shall] may require families to pay copayments [and make premium contributions, based upon a sliding income scale]. The program shall include the provision of well-child and other preventive services, hospitalization, physician care, laboratory and x-ray services, prescription drugs, mental health services, and other services as determined by the commissioner.
b. The commissioner shall take such actions as are necessary to implement and operate the program in accordance with the State Children's Health Insurance Program established pursuant to 42 U.S.C.s.1397aa et seq.
c. The commissioner:
(1) shall, by regulation, establish standards for determining eligibility and other program requirements [, including, but not limited to, restrictions on voluntary disenrollments from existing health insurance coverage];
(2) shall require that a parent or caretaker who is a qualified applicant purchase coverage, if available, through an employer-sponsored health insurance plan which is determined to be cost-effective and is approved by the commissioner, and shall provide assistance to the qualified applicant to purchase that coverage, except that the provisions of this paragraph shall not be construed to require an employer to provide health insurance coverage for any employee or employee's spouse or dependent child;
(3) may, by regulation, establish plans of coverage and benefits to be covered under the program, except that the provisions of this section shall not apply to coverage for medications used exclusively to treat AIDS or HIV infection; and
(4) shall establish, by
regulation, other requirements for the program, including, but not limited to, [premium payments
Except as may be required for the NJ FamilyCare Advantage program established pursuant
j. of this section, premiums shall not be established within the program. The commissioner may contract with one or more appropriate entities, including managed care organizations, to assist in administering the program. The period for which eligibility for the program is determined shall be the maximum period permitted under federal law.
d. The commissioner shall establish procedures for determining eligibility, which shall include, at a minimum, the following enrollment simplification practices:
(1) A streamlined application form as established pursuant to subsection k. of this section;
(2) Require new applicants to submit one recent pay stub from the applicant's employer, or, if the applicant has more than one employer, one from each of the applicant's employers, to verify income. In the event the applicant cannot provide a recent pay stub, the applicant may submit another form of income verification as deemed appropriate by the commissioner. If an applicant does not submit income verification in a timely manner, before determining the applicant ineligible for the program, the commissioner shall seek to verify the applicant's income by reviewing available Department of the Treasury and Department of Labor and Workforce Development records concerning the applicant, and such other records as the commissioner determines appropriate.
The commissioner shall establish retrospective auditing or income verification procedures, such as sample auditing and matching reported income with records of the Department of the Treasury and the Department of Labor and Workforce Development and such other records as the commissioner determines appropriate.
In matching reported income with confidential records of the Department of the Treasury, the commissioner shall require an applicant to provide written authorization for the Division of Taxation in the Department of the Treasury to release applicable tax information to the commissioner for the purposes of establishing income eligibility for the program. The authorization, which shall be included on the program application form, shall be developed by the commissioner, in consultation with the State Treasurer;
(3) Online enrollment and renewal, in addition to enrollment and renewal by mail. The online enrollment and renewal forms shall include electronic links to other State and federal health and social services programs;
(4) Continuous enrollment;
(5) Simplified renewal by sending an enrollee a preprinted renewal form and requiring the enrollee to sign and return the form, with any applicable changes in the information provided in the form, prior to the date the enrollee's annual eligibility expires. The commissioner shall establish such auditing or income verification procedures, as provided in paragraph (2) of this subsection; [and]
(6) Provision of program eligibility-identification cards that are issued no more frequently than once a year; and
(7) Provision of information regarding other health care programs for which an enrollee may be eligible to any enrollee terminated from the program.
e. The commissioner shall take, or cause to be taken, any action necessary to secure for the State the maximum amount of federal financial participation available with respect to the program, subject to the constraints of fiscal responsibility and within the limits of available funding in any fiscal year. In this regard, notwithstanding the definition of "qualified applicant," the commissioner may enroll in the program such children or their parents or caretakers who may otherwise be eligible for the Medicaid program in order to maximize use of federal funds that may be available pursuant to 42 U.S.C. s.1397aa et seq.
f. [Subject to federal approval, a child shall be determined ineligible for the program if the child was voluntarily disenrolled from employer-sponsored group insurance coverage within six months prior to application to the program] No child who applies for enrollment in the program who otherwise meets the eligibility criteria for enrollment shall be denied immediate enrollment for any reason. In no case shall any qualified applicant for enrollment be subject to a waiting period prior to enrollment.
g. The commissioner shall provide, by regulation, for presumptive eligibility for the program in accordance with the following provisions:
(1) A child who presents [himself] for treatment at a general hospital, federally qualified or community health center, local health department that provides primary care, or other State licensed community-based primary care provider shall be deemed presumptively eligible for the program if a preliminary determination by hospital, health center, local health department or licensed health care provider staff indicates that the child meets program eligibility standards and is a member of a household with an income that does not exceed [350%] 350 percent of the poverty level;
(2) The provisions of paragraph (1) of this subsection shall also apply to a child who is deemed presumptively eligible for Medicaid coverage pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.);
(3) The parent or caretaker of a child deemed presumptively eligible pursuant to this subsection shall be required to submit a completed application for the program no later than the end of the month following the month in which presumptive eligibility is determined;
(4) A child shall be eligible to receive all services covered by the program during the period in which the child is presumptively eligible; and
(5) The commissioner may, by regulation, establish a limit on the number of times a child may be deemed presumptively eligible for NJ FamilyCare.
h. The commissioner, in consultation with the Commissioner of Education, shall administer an ongoing enrollment initiative to provide outreach to children throughout the State who may be eligible for the program.
(1) With respect to school-age children, the commissioner, in consultation with the Commissioner of Education and the Secretary of Agriculture, shall develop a form that provides information about the NJ FamilyCare and Medicaid programs and provides an opportunity for the parent or guardian who signs the school lunch application form to give consent for information to be shared with the Department of Human Services for the purpose of determining eligibility for the programs. The form shall be attached to, included with, or incorporated into, the school lunch application form.
The commissioner, in consultation with the Commissioner of Education, shall establish procedures for schools to transmit information attached to, included with, or provided on the school lunch application form regarding the NJ FamilyCare and Medicaid programs to the Department of Human Services, in order to enable the department to determine eligibility for the programs.
(2) The commissioner or the Commissioner of Education, as applicable, shall:
(a) make available to each elementary and secondary school, licensed child care center, registered family day care home, unified child care agency, local health department that provides primary care, and community-based primary care provider, informational materials about the program, including instructions for applying online or by mail, as well as copies of the program application form.
The entity shall make the informational and application materials available, upon request, to persons interested in the program; and
(b) request each entity to distribute a notice at least annually, as developed by the commissioner, to households of children attending or receiving its services or care, informing them about the program and the availability of informational and application materials. In the case of elementary and secondary schools, the information attached to, included with, or incorporated into, the school lunch application form for school-age children pursuant to this subparagraph shall be deemed to meet the requirements of this paragraph.
i. Subject to federal approval, the commissioner shall, by regulation, establish that in determining income eligibility for a child, any gross family income above [200%] 200 percent of the poverty level, up to a maximum of [350%] 350 percent of the poverty level, shall be disregarded.
j. The commissioner shall establish a NJ FamilyCare coverage buy-in program [through which a parent or caretaker whose family income exceeds 350% of the poverty level may purchase coverage under NJ FamilyCare for a child under the age of 19, who is uninsured and was not voluntarily disenrolled from employer-sponsored group insurance coverage within six months prior to application to the program. The program] , which shall be known as NJ FamilyCare Advantage.
The commissioner shall establish the premium and cost sharing amounts required to purchase coverage, except that the premium shall not exceed the amount the program pays per month to a managed care organization under NJ FamilyCare for a child of comparable age whose family income is [between 200% and 350%] less than 350 percent of the poverty level, plus a reasonable processing fee.
k. The commissioner, in consultation with the Rutgers Center for State Health Policy, shall develop a streamlined application form for the NJ FamilyCare and Medicaid programs.
l. [Subject to federal approval, the] The Commissioner of Human Services shall establish a hardship waiver for part or all of [the] any premium [for an eligible child under the NJ FamilyCare program] authorized under this section. A parent or caretaker may apply to the commissioner for a hardship waiver in a manner and form established by the commissioner. If the parent or caretaker can demonstrate to the satisfaction of the commissioner, pursuant to regulations adopted by the commissioner, that payment of all or part of the premium for the parent or caretaker's child presents a hardship, the commissioner shall grant the waiver for a prescribed period of time.
(cf: P.L.2008, c.53, s.2)
2[2. Section 11 of P.L.2005, c.156 (C.30:4J-14) is amended to read as follows:
11. The Commissioner of Human Services shall [report to the Chairman of the Senate Health, Human Services and Senior Citizens Committee and the Chairmen of the Assembly Health and Human Services and Assembly Family, Women and Children's Issues committees on the implementation of this act.
The commissioner shall] issue an interim report six months after the effective date of [this act] P.L. , c. (C. ) (pending before the Legislature as this bill) and shall issue an annual report six months later and once each year thereafter. Each report shall be submitted to the Governor and to the Legislature, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), and published on the department’s Internet website.
The [report] reports shall be prepared with input from the working group established pursuant to section 27 of P.L.2008, c.38 (C.30:4J-19), and shall include information on the department’s actions, and the outcomes of such actions, to make affordable, quality healthcare coverage available to all children in New Jersey and the extent to which coverage disparities based on income, race, ethnicity, and geography have changed over the reporting period. The reports shall also include the number of persons who are enrolled in the Medicaid and NJ FamilyCare programs pursuant to the provisions of [this act] P.L.2005, c.156 (C.30:4J-8 et al.), the cost of providing coverage for these persons, the status of any Medicaid plan amendments or waivers necessary for implementation of [this act] P.L.2005, c.156 (C.30:4J-8 et al.), the status of implementing the enrollment simplification practices for both the NJ FamilyCare and Medicaid programs, and such other information as the commissioner deems appropriate. The commissioner may also include any recommendations for legislation [he deems] deemed necessary to further the purposes of [this act] P.L.2005, c.156 (C.30:4J-8 et al.).
(cf: P.L.2005, c.156, s.11)]2
2[3.] 2.2 Section 26 of P.L.2008, c.38 (C.30:4J-18) is amended to read as follows:
26. 2[a.]2 The Commissioner of Human Services shall establish an enhanced NJ FamilyCare outreach and enrollment initiative to increase public awareness about the availability of, and benefits to enrolling in, Medicaid, NJ FamilyCare, and the NJ FamilyCare Advantage buy-in programs. The initiative shall [include] be coordinated with any outreach efforts implemented pursuant to subsection h. of section 5 of P.L. 2005, c.156 (C.30:4J-12) or related to enrollment in the State’s health insurance Exchange established pursuant to the federal “Patient Protection and Affordable Care Act,” Pub.L.111-148, as amended by the "Health Care and Education Reconciliation Act of 2010," Pub.L.111-152, and shall include:
2[(1)] a. providing input to the Commissioner of Banking and Insurance for2 the provision of training to Exchange enrollment assistors, 2and, as determined by the commissioner, the provision of training to2 local officials 2[,]2 and any other pertinent staff 2[, as determined by the commissioner,]2 on the eligibility requirements of the NJ FamilyCare program and how to enroll children in the program;
2[(2)] b.2 culturally sensitive, Statewide and local media public awareness campaigns addressing the availability of health care coverage for parents and children under the Medicaid and NJ FamilyCare programs and health care coverage for children under the NJ FamilyCare Advantage buy-in program [.The initiative shall also include] ; and
2[(3)] c.2 the provision of training and support services, upon request, to community groups, legislative district offices, and community-based health care providers to enable these parties to assist in enrolling parents and children in the applicable programs.
2[b. The Department of Banking and Insurance, in consultation with the Commissioner of Human Services, shall take steps to ensure the full incorporation of the Medicaid, NJ FamilyCare and NJ FamilyCare Advantage Programs on the State’s health insurance Exchange and the individual health coverage marketplace. In order to ensure that Medicaid and NJ FamilyCare eligibility is properly evaluated, plan comparison and cost tools shall solicit current expected monthly income in lieu of or in addition to annual income.]2
(cf: P.L.2008, c.38, s.26)
2[4.] 3.2 Section 27 of P.L.2008, c.38 (C.30:4J-19) is amended to read as follows:
27. The Commissioner of Human Services shall establish an Outreach, Enrollment, and Retention Working Group to develop a plan to carry out ongoing and sustainable measures to strengthen outreach to low and moderate income families who may be eligible for Medicaid, NJ FamilyCare, or NJ FamilyCare Advantage, to maximize enrollment in these programs, and to ensure retention of enrollees in these programs.
a. The members of the working group shall include:
(1) The Commissioners of Human Services, Health, Banking and Insurance, Children and Families, Labor and Workforce Development, Education, and Community Affairs, and the Secretary of Agriculture, or their designees, who shall serve ex officio; and
(2) [Six] Ten public members appointed by the Commissioner of Human Services who shall include: one person who represents racial and ethnic minorities in this State; one person who represents managed care organizations that participate in the Medicaid and NJ FamilyCare programs; one person who represents the vendor under contract with the Division of Medical Assistance and Health Services to provide NJ FamilyCare eligibility, enrollment, and health benefit coordinator services to the division; one person who represents New Jersey Policy Perspective; one person who represents the Advocates for Children of New Jersey; [and] one person who represents Legal Services of New Jersey; one person who represents the New Jersey Health Care Quality Institute; one person who represents county navigators; and two people who represent the New Jersey for Health Care coalition.
b. As part of the plan, the working group shall:
(1) determine if there are obstacles to enrollment of minorities in the State in the Medicaid, NJ FamilyCare, and NJ FamilyCare Advantage programs due to ethnic and cultural differences and, if so, develop strategies for the Department of Human Services to overcome these obstacles and increase enrollment among minorities;
(2) recommend outreach strategies to identify and enroll all eligible children in the Medicaid, NJ FamilyCare, and NJ FamilyCare Advantage programs and to retain enrollment of children and their parents in the programs;
(3) establish monthly enrollment goals for the number of children who need to be enrolled in Medicaid, NJ FamilyCare, and NJ FamilyCare Advantage in order to ensure that as many children as possible who are eligible for these programs are enrolled within a reasonable period of time, in accordance with the mandate established pursuant to section 2 of P.L.2008, c.38 (C.26:15-2); and
(4) make such other recommendations to the Commissioner of Human Services as the working group determines necessary and appropriate to achieve the purposes of this section.
c. The working group shall organize [as soon as practicable following the appointment of its members and] and hold a meeting no later than 60 days following the date of enactment of P.L. , c. (C. ) (pending before the Legislature as this bill). The working group shall select a chairperson and vice-chairperson from among the members. The chairperson shall appoint a secretary who need not be a member of the working group.
(1) The public members shall serve without compensation, but shall be reimbursed for necessary expenses incurred in the performance of their duties and within the limits of funds available to the working group.
(2) The working group shall be entitled to call to its assistance and avail itself of the services of the employees of any State, county, or municipal department, board, bureau, commission, or agency as it may require and as may be available to it for its purposes.
d. Upon completion of the plan, the working group shall report on its activities to the chairperson of the Senate and Assembly standing reference committees on health and human services, and include a copy of the plan and any recommendations for legislative action it deems appropriate.
e. The Commissioner of Human Services shall post the plan on the department's Internet website and include a table showing the monthly enrollment goals established in the plan and the actual new and continued enrollments for that month. The commissioner shall update the table monthly.
f. The Department of Human Services shall provide staff support to the working group.
(cf: P.L.2012, c.17, s.397)
2[5.] 4.2 (New section) There 1[is appropriated] shall be an annual appropriation1 from the General Fund to the Department of Human Services 1in1 the sum of $20,000,000 for the purposes of implementing the provisions of this act.
2[6.] 5.2 (New section) The Commissioner of Human Services may adopt rules and regulations, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), as shall be necessary to implement the provisions of this act.
2[7.] 6.2 (New section) The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program and for NJ FamilyCare expenditures under the State Children's Health Insurance Program pursuant to 42 U.S.C. s.1397aa et seq.
2[8.] 7.2 This act shall take immediately.